Healthcare Provider Details

I. General information

NPI: 1841504891
Provider Name (Legal Business Name): TAMARA ANNE RICAFORTE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 E 22ND ST APT. 16S
NEW YORK NY
10010-5315
US

IV. Provider business mailing address

5 E 22ND ST APT. 16S
NEW YORK NY
10010-5315
US

V. Phone/Fax

Practice location:
  • Phone: 203-520-1084
  • Fax:
Mailing address:
  • Phone: 203-520-1084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number0155081
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: